Background Information:

What are the other Names for the Procedure?

• Caesarean Section
• Cesarean Delivery
• C-Section

What is Cesarean Section surgical procedure?

Cesarean Section (or C-Section) is a surgical procedure where an incision is made in the lower abdomen, carried down through the muscle and then through the uterus of the mother, to deliver the baby. It is a common procedure performed worldwide.

What part of the Body does the Procedure involve?

The Cesarean Section procedure involves the lower abdominal wall, uterus, placenta and fetus.

Why is the Cesarean Section surgical procedure Performed?

There could be various reasons for performing a Cesarean Section. Some of these are as follows:

• The baby’s head is big to pass through the vagina
• Failure to undergo normal labor
• Inability to have enough contractions or slow contractions
• Fetal distress
• Acute genital infections e.g. herpes virus infection
• The baby’s position in the uterus
• Problem with the umbilical cord or placenta, such as cord around the fetus neck, or abnormal location of the placenta
• Multiple pregnancy (especially if prior delivery is conducted via Cesarean section)
• If the mother suffers from any severe ailment, like a heart condition, brain aneurysm, etc.

What are some Alternative Choices for the Procedure?

A Cesarean Section is considered a gold standard technique, if a normal vaginal delivery puts the baby or the mother at any risk.

What are the Recent Advances in the Procedure?

Currently, there are no major advances made in the C-Section procedure.

What is the Cost of performing the Cesarean Section surgical procedure?

The cost of Cesarean Section procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Cesarean Delivery surgical procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.nlm.nih.gov/medlineplus/cesareansection.html

http://www.mayoclinic.com/health/c-section/MY00214

Prior to Cesarean Section surgical procedure:

How is the Cesarean Section surgical procedure Performed?

A C-Section is performed in the following manner:

• A vertical or transverse incision is made on the lower abdomen of the patient, and carried down through the underlying tissue (i.e., different layers of the abdominal wall including fat, muscle, fascia, peritoneum)
• It is then passed through the uterine wall to expose the baby
• The surgeon removes the placenta and the baby from the uterine cavity
• Lastly the uterine wall, abdominal wall, tissue and skin are closed with sutures and bandaged

Where is the Procedure Performed?

The Cesarean Section procedure is performed in a hospital, where the patient gets admitted, undergoes the procedure and is discharged, as per the instruction of the physician.

Who Performs the Procedure?

A Cesarean Section procedure is performed by an obstetrician/gynecologist along with an anesthesiologist. Occasionally, a family practitioner may also perform this surgical procedure.

How long will the Procedure take?

A C-Section procedure may take anywhere between half an hour to 2 hours (in case of any complications), to perform.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine, if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Cesarean Section procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Cesarean Section surgical procedure?

The following tests are required by the physician before the Cesarean Section procedure:

• Routine blood and urine analysis
• Ultrasound (abdominal) scan
• Some other blood tests may be necessary prior to the procedure. The physician shall determine the extent of blood tests needed.  

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Cesarean Section procedure?
• Why is this procedure necessary?
• What does the procedure involve?
• How will this procedure help?
• Will I be able to have normal deliveries in future?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• Am I or my baby at any risk?
• What are the complications that might take place while recovering?
• When can I resume normal work?
• Is there any lifestyle restrictions needed, after the procedure is performed?
• After recovering from the procedure, are there any follow ups or tests? If yes, how often?
• Is there any lifelong medication that needs to be taken after the procedure?
• How many procedure have you performed? 

During the Cesarean Section surgical procedure:

What kind of Anesthesia is given, during the Procedure?

During the Cesarean Section procedure the patient is administered spinal anesthesia or general anesthesia.

How much Blood will you lose, during the Procedure?

Since a C-Section procedure involves making deep incisions, the blood loss involved varies from one patient to another. Generally, the blood loss is minimal in a majority of the cases.

What are the possible Risks and Complications during the Cesarean Section surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally greater the degree of obesity, greater is the surgical risk
• Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders, chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the Cesarean Section surgery are:

• Excessive bleeding
• Infection
• Blood clots in the leg or lungs
• Injury to the adjacent structures
• Anesthetic complications

What Post-Operative Care is needed at the Healthcare Facility after the Cesarean Section surgical procedure?

At the healthcare facility, generally there is minimal post-procedure care necessary, unless any complications arise. However, the patient is monitored closely and wound care given. The patient may be admitted for 4-8 hours or more, prior to discharge.

After the Cesarean Section surgical procedure:

What are the possible Risks and Complications after the Cesarean Section surgical procedure?

Post Cesarean Delivery, the following complications may arise:

• Infection in the surgical wound
• Excessive loss of blood
• Bleeding from the incisional wound
• Urinary tract infection
• Problems to the baby such as breathing problems
• Pain and discomfort
• Incisional hernia
• Post-delivery depression

What is the Prognosis after the Surgery?

The prognosis of Cesarean Section surgical procedure is excellent in most cases.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Pain around the surgical wound
• Excessive bleeding from the vagina
• Swelling and redness
• Bleeding or drainage
• Constipation
• Fever
• Vaginal discharge
• Urge to urinate often
• Dizziness
• Muscle ache
• Nausea or vomiting
• Signs of infection
• If any new symptom or discomfort is observed

What Post-Operative Care is needed at Home after the Cesarean Section surgical procedure?

At home, the following post-operative care is recommended, after a Cesarean Section procedure:

• Complete the course of medication, if any
• Avoid strenuous exercises
• Use heating pad to ease surgical pain
• Wash the puncture site with mild soap while bathing
• Elevate your feet while resting
• Resume daily activity only after the patient feels better
• Avoid sex, till 6 weeks after delivery (under physician’s advice)

How long does it normally take to fully recover, from the Procedure?

It takes about 4-6 weeks to completely recover from a C-Section surgery.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

Since placental tissue is removed during the procedure, a pathologist may examine the placenta, if requested by the physician performing the C-Section.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

It may take about 3 days for the pathologist to issue a pathology report.

Who will you receive a Bill from, after the Cesarean Section surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The hospital
• An obstetrician/gynecologist
• An anesthesiologist (if anesthesia was administered)
• A radiologist (if radiological tests were performed during the procedure)
• A pathologist, if the placenta is sent for examination to the laboratory

Individuals are advised to inquire and confirm the type of billing, before the Cesarean Section surgical procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA